Individual
CORY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3813 S KIWANIS CIR, SIOUX FALLS, SD 57105-4266
(605) 332-1095
Mailing address
3813 S KIWANIS CIR, SIOUX FALLS, SD 57105-4266
(605) 332-1095
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7015
NE
1223P0221X
Pediatric Dentistry
Primary
D1227
SD
390200000X
Student in an Organized Health Care Education/Training Program
R668
MN
Other
Enumeration date
03/08/2012
Last updated
05/08/2025
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